From the Guidelines
Spironolactone may be considered for patients with heart failure with preserved ejection fraction (HFpEF) who have an ejection fraction ≥45%, elevated BNP levels, and specific criteria, including estimated glomerular filtration rate >30 mL/min, creatinine <2.5 mg/dL, and potassium <5.0 mEq/L, as evidenced by the 2022 AHA/ACC/HFSA guideline 1. The use of spironolactone in HFpEF is supported by the TOPCAT trial, which showed a reduction in heart failure hospitalizations, particularly in patients with elevated natriuretic peptides 1. However, it's crucial to carefully monitor potassium levels and renal function to minimize the risk of hyperkalemia and worsening renal function. Key considerations for the use of spironolactone in HFpEF include:
- Starting dose: 10-25 mg daily, titrated up to 25-50 mg daily as tolerated
- Monitoring: potassium levels and renal function at 1 week, 1 month, and then every 3 months
- Contraindications: severe renal dysfunction (eGFR <30 mL/min), potassium >5.0 mEq/L, or use of other potassium-sparing medications
- Side effects: hyperkalemia, gynecomastia in men, and worsening renal function. The 2022 guideline 1 provides the most recent and highest quality evidence for the use of spironolactone in HFpEF, superseding earlier guidelines such as the 2017 ACC/AHA/HFSA focused update 1.
From the Research
Spironolactone and Preserved Ejection Fraction Heart Failure
- There is no direct evidence in the provided studies regarding the use of spironolactone in patients with preserved ejection fraction heart failure.
- However, the studies discuss the diagnosis and management of heart failure with preserved ejection fraction (HFpEF) 2, 3, 4, 5.
- The treatment of HFpEF is mainly focused on managing symptoms, such as congestion, and addressing underlying conditions like hypertension 3, 5.
- Diuretics are commonly used to treat congestive symptoms in HFpEF patients 3.
- Other medications, such as angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, and beta-blockers, may be used in certain cases, but their effectiveness in improving clinical outcomes in HFpEF is not well established 2, 3.
- Recent studies have explored new approaches to diagnosis and management, including the use of SGLT2 inhibitors, which may be beneficial in HFpEF patients 6.
- The management of HFpEF is complex and often requires a holistic approach, taking into account the patient's underlying conditions, symptoms, and overall health status 6.